HomeMy WebLinkAboutCertificate of Inspection 12/3/2019 The Commonwealth of Massachusetts
City\Town of
YARMOUTH
New and Renewal Certificate of Inspection
In accordance with 780 CMR, Chapter 1 (The Eighth Edition of the Massachusetts State Building Code)and Chapter 304 of the Acts of 2004(an Act to further
enhance fire and life safety),this certificate of inspection is issued to the premise or structure or part thereof as herein identified.
Identify Name of Establishment Certificate No.
Issued to
Business Name:OLIVER ORMON, INC.dba BLDCI-17-002988-03
Trade Name:OLIVER'S EATING&DRINKING ESTABLISHMENT
Identify property address including street number,name,city or town and county Certificate Expiration
Located at
960 ROUTE 6A 12/31/2020
YARMOUTH, MA 02675
Use Group Floor Occupancy Use Group Other
Classifications(s)
A-2 01 st Floor 227 A-2 Nightclub/Restaurant/Bar/Banquet Hall 85-MAIN DINING
67-SMALL DINING
74-BAR-LOUNGE
Allowable TOTAL:227
Occupant Load
This certificate of inspection is hereby issued by the undersigned to certify that the premise,structure or portion thereof as herein specified has been inspected
for general fire and life safety features. This certificate shall be framed behind glass and/or laminated and posted in a conspicuous place within the space as
directed by the undersigned. Failure to pose or tampering with the contents of the certificate is strictly prohibited.
Name of Municipal Philip Simonian Ill Name of Municipal Mark G Date of �
Fire Chief Building Commissioner Inspection //
l
Signature of Municipal Signature of Municipal Date of
Fire Chief Bu' ing Commissioner Issuance //L. 3.19
Fee:$150.00
BLD_Certoflnspection.rpt
YgRo TOWN OF YARMOUTH
• oul. ` ' BUILDING DEPARTMENT
L MANTA FP S[4'
�, �••a••r o� 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260
APPLICATION FOR CERTIFICATE OF INSPECTION
October 1, 2019 PAYABLE UPON RECEIPT
(X) Fee Required 150.00
( ) No Fee Required
In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, I hereby apply for a
Certificate of Inspection for the below-named premises located at the following address:
Street and Number: 960 I"1/ k) (. '!
/ t
Name of Premises: Ot i V Lg, s "r FLA A1Gl S Tel: ,<;6"-36-2-‘a<0 Z.
Purpose for which permit is used: 2i:7S i A-a/Z4 r•.)f
License(s) or Permit(s) required for the premises by other governmental agencies:
License or Permit Agency l^�j,' 1 1 201.'4
Certificate to be issued to 2t.0 O R I'IO"' Tel: 8-•362-6 ocz
Address: Zi4 el g
Owner of Record of Building 6LANlJ 't (.6/4 L-L' OR M DN
Address HA/A) sir YA+2 wc(Pori( ` 02�—
Present Holder of Certificate ?Aur cJ o�
611
Signature of person to whom Title
Certificate is issued or his agent /0- s'-/l
Date
Email Address: o R MON - d L(tl�/z--S @ 6,(60"S. JJ
Instructions: Make check payable to: Town of Yarmouth
1146 Route 28, South Yarmouth, MA 02664
Return this application to: Building Inspector's Office
Please note: Application form with accompanying fee must be submitted for each building or structure or part thereof
to be certified. Application must be received before the certificate will be issued. The building official shall be
notified within ten(10) days of any change in the above information.
PLEASE SEND US A COPY OF YOUR WORKER'S COMPENSATION INSURANCE FORM WITH THIS
APPLICATION OR WE CANNOT ISSUE YOUR CERTIFICATE OF INSPECTION.
Certificate of Inspection#8W-4.7 - /70 Z91 0 3
12/30/2019-12/30/2020
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NOTICE NOTICE
TO -- — TO
EMPLOYEES = 1a= EMPLOYEES
_5
The Commonwealth of Massachusetts
DEPARTMENT OF INDUSTRIAL ACCIDENTS
1 Congress Street, Suite 100, Boston, Massachusetts 02114-2017
617-727-4900 - http://www.state.ma.us/dia
As required by Massachusetts General Law, Chapter 152, Sections 21, 22 & 30,this will give you notice that I (we)
have provided for payment to our injured employees under the above-mentioned chapter by insuring with:
MA Retail Merchants WC Group Inc.
NAME OF INSURANCE COMPANY
PO Box 859222-9222, Braintree, MA 02185-0000
ADDRESS OF INSURANCE COMPANY
014000502163119 01/01/19 - 01/01/20
POLICY NUMBER EFFECTIVE DATES
Rogers& Gray Insurance Agency, Inc. 434 Route 134, South Dennis, MA 02660 0
NAME OF INSURANCE AGENT ADDRESS PHONE #
Oliver's Eating & Drinking 6 Bray Farm Road, Yarmouthport, MA
02675-0000
EMPLOYER ADDRESS
01/10/2019
EMPLOYER'S WORKERS' COMPENSATION OFFICER(IF ANY) DATE
MEDICAL TREATMENT
The above named insurer is required in cases of personal injuries arising out of and in the course of employment to
furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers'
Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may
select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by
the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring
hospital attention, employees are hereby notified that the insurer has arranged for such attention at the
NAME OF HOSPITAL ADDRESS
TO BE POSTED BY EMPLOYER
t
r
a
TOWN OF YARMOUTH BBUILDINit L
EA ` GAS
C;ts ; 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451
"1•41 Z: PLUMBING
II Telephone (508) 398-2231, Ext. 261 —Fax (508) 398-0836
SIGNS
BUILDING DEPARTMENT
Inspection and License Report Date /A-,1A-77
Address / C� 4 CJ Te b 49 Business Name Cam-///L'f is
Contact Phone
During the Annual Inspection of your premises,performed in accordance with the provisions of Section 110.7 of 780 CMR(Massachusetts
State Building Code),the Board of Selectmen,and/or the Board of Health rules,the following violation(s)were observed:
Agrai
❑Emergency egress signage Location / � �'� �%V1,7/
❑Emergency egress lighting Location V
❑Maintenance of exits Location re 1`'� . u 1 r`// '//7�� / `J l% �" � " f4`�
❑ Guards/handrails Location i 4 7e/ 4� , /
aping
(]Signs Location //OTC C"i 6I�/\ J�c-c�a� (J'ST` 7 cd/
y
❑ Parking Location y�,/
❑ Other Locationy75�JrtU � CZ,/ D./ 017. /622
Mechanical
ElCombustion Air Location 147 t"
❑Storage in Boiler Room Location
Vents Location
❑Automatic door closures
on boiler room doors Location
❑ Clothes dryer vents Location
(2thtz Location
The State Building Code,Section 1001.3-Maintenance,provides that the owner as defined in Section 780 CMR shall be
responsible for proper maintenance.
In order to abate the above violation(s)you must:
o Make corrections immediately and contact this office for a follow-up inspection.
o Make corrections prior to opening and contact this office for a follow-up inspection.
o.Make corrections prior to your next annual inspection.
o Make corrections within vv,y,7 days and contact this office for a follow-up inspection.
Local Official/Inspector 4�-n9
Received By w � 4 r Title
Revised 2/8/13